Exacerbation of Bronchiectasis (other than secondary to Cystic Fibrosis) - Outpatient treatment

Duration

7 days if mild, 10 days if moderate, 14 days if severe

No colonisation with P.aeruginosa

Important: Therapy

Amoxicillin PO 1 g every 8 hours

or Clarithromycin PO 250-500 mg twice daily

or Doxycycline PO 200mg on day 1 then 100mg daily

Notes:

In pregnant patients doxycycline is contraindicated.

Clarithromycin should not be prescribed concurrently with ciclosporin, sirolimus and tacrolimus.

Colonised with P.aeruginosa

Important: Therapy

Base treatment on reported susceptibilities. See section on Isolates reported as "I" for further information on dosing of ciprofloxacin.
If the isolate has been reported as resistant ("R" only) to ciprofloxacin, or the patient is unwell enough to warrant admission, discuss therapy with a respiratory physician or Infection Specialist.

Notes:

The only orally available antimicrobials with possible anti-pseudomonal activity are quinolones. The reported quinolone on P.aeruginosa isolates is ciprofloxacin.
P.aeruginosa is never reported susceptible ("S") to ciprofloxacin, but can only be susceptible at increased dose ("I") or resistant ("R").
P.aeruginosa reported as "R" to ciprofloxacin cannot be treated with oral antimicrobials.

Important: Notes

In patients with known bronchiectasis, acute exacerbations should be treated with antibiotics if the patient reports increased purulence of sputum AND increased sputum volume or viscosity, AND one or several of:

increased shortness of breath,
worsening wheeze,
increased cough,
or systemic upset.

Sputum samples should be sent for any patient with exacerbation of bronchiectasis.

In primary care, consider hospitalisation if features of a severe exacerbation are present, such as

marked dyspnoea, tachypnoea, hypoxia (<90% on room air), pursed-lip breathing, use of accessory muscles at rest,
acute confusion,
new-onset cyanosis,
peripheral oedema, or
marked reduction in performing usual activities of daily living